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Semin Oncol. 2018 Aug;45(4):232-235. doi: 10.1053/j.seminoncol.2018.07.002. Epub 2018 Oct 11.

Metastatic neuroendocrine tumors of the gastrointestinal tract and pancreas: A surgeon's plea to centering attention on the liver.

Author information

1
Rush University Medical Center, Department of Surgery, Division of Surgical Oncology, Chicago, IL, USA. Electronic address: Xavier_keutgen@rush.edu.
2
Rush University Medical Center, Department of Surgery, Division of Surgical Oncology, Chicago, IL, USA; Cantonal Hospital Winterthur, Department of Surgery, Winterthur, Zurich, Switzerland; University of Zurich, Institute of Physiology, Zurich, Switzerland.
3
Oregon Health & Science University, Department of Surgery, Division of Surgical Oncology, Portland, OR, USA.
4
Mayo Clinic, Department of Oncology, Division of Medical Oncology, Rochester, MN, USA.
5
University of Iowa, Department of Surgery, Division of Surgical Oncology, Iowa City, IA, USA.
6
Stanford University, Department of Surgery, Division of Surgical Oncology, Stanford, CA, USA.

Abstract

Over 50% of patients with gastroenteropancreatic neuroendocrine tumors (GEP-NETs) have stage IV disease at presentation and the most likely organ to be affected by metastases is the liver. Hepatic involvement and hepatic tumor burden is a key prognostic factor affecting survival of these patients and 80% eventually die of liver failure due to tumor dissemination within the liver. This commentary explores the efficacy and limitations of systemic treatments in patients with GEP-NETs and liver metastases. Landmark randomized trials using systemic therapies including sandostatin (PROMID), lanreotide (CLARINET), everolimus (RADIANT 3 and 4), sunitinib and Peptide Receptor Radionuclide Therapy (NETTER-1) have not shown efficacy in reducing liver tumor burden in patients with stage IV GEP-NETs with liver metastases as outlined in this review. Although often overlooked, surgical debulking has been associated with a significant survival advantage in large retrospective studies and in our opinion should remain an important therapeutic option for patients with stage IV GEP-NETs and liver metastases.

KEYWORDS:

Liver metastases; Liver resection; Neuroendocrine tumor; Systemic therapy

[Indexed for MEDLINE]

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